ANATOMICAL LANDMARKS

OF MAXILLA
M.M Devan Dictum “Aim of a prosthodontist is not only
the meticulous replacement of what is missing, but also
perpetual preservation of what is present”

A prosthesis must function in harmony with the tissues

that support them and those that surround them.

Hence the dentist must understand the macroscopic as well

as microscopic anatomy of the supporting and limiting
structures of the denture.
ANATOMY OF DENTURE
BEARING
AREAS
 The anatomy of edentulous ridges in the maxilla and
mandible is very important for the design of the complete
denture.

 The average available denture bearing area for an

edentulous mandible is 14cm2, whereas for
edentulous maxilla it is 24cm2. Therefore the mandible is less
capable of resisting occlusal forces than the maxilla.
THE ORAL MUCOUS MEMBRANE

Divided into 3 categories depending on location

in the mouth:
1) Masticatory mucosa: covers the crest of
residual ridge including residual attached gingiva
and hard palate.
2) Lining mucosa: covers the mucous
membrane, not firmly attached to periosteum.
3) Specialized mucosa: covers the dorsal surface
of tongue.
 ANATOMY OF DENTURE
BEARING AREA - MAXILLA
 The ultimate support for the maxillary denture are the bones
of the two maxilla and the palatine bone.

 The anatomical land marks in the maxilla are

LIMITING STRUCTURES
SUPPORTING STRUCTURES
RELIEF AREAS
 Limiting structures are sites that will guide us in having an
optimum extension of denture so as to engage
maximum surface area without encroaching upon the
muscle action.
 These are structures that limit the extent of the denture:
• Labial frenum
• Labial vestibule
• Buccal frenum
• Buccal vestibule
• Hamular notch
• Posterior palatal seal
• Fovea palatinae
 Single or double fibrous band
covered by mucous membrane which
extends from labial aspect of residual
alveolar ridge to the lip.

 Absence of muscle fibers.

CLINICAL SIGNIFICANCE
 Limits labial flange of denture.
 It has to be relieved while making
impression in other to
dislodgement of the denture
preventand to
prevent ulceration. It is seen as a
V- shaped notch in the impression.
 It extends from buccal frenum on one side to
the other, being divided into right and left
by labial frenum.
 Anteriorly: orbicularis oris muscle
 Posteriorly: labial aspect of alveolar ridge.

It has a thin mucosa and thick

submucosa with large amount of loose
areolar tissue and elastic fibers.

CLINICAL SIGNIFICANCE
 The labial flange of the denture will be in
complete contact with labial vestibule
to provide a peripheral seal in the denture.
  Band of fibrous tissue overlying the levator
anguli oris, that divides labial vestibule from
buccal vestibule.
 The orbicularis oris pulls frenum forward and the
buccinator pulls it backward.

CLINICAL SIGNIFICANCE

 It requires more clearance for its action than

labial frenum because it moves mesially,
buccally and vertically by orbicularis oris,
buccinator and levator anguli oris respectively.
Buccal vestibule extends from the buccal
frenum to the hamular notch. Bounded
externally by cheeks and internally by
residual alveolar ridge.
The size of the vestibule varies with the
contraction of the buccinator muscle.

CLINICAL SIGNIFICANCE

Compared to labial flange, buccal flange has

less interference and so provides
maximum retention.
 Hamular notch forms the distal limit of
the buccal vestibule, located between the
tuberosity and the hamulus of the medial
pterygoid plate.

 Pterygomandibular raphe is attached to the

hamular notch.

CLINICAL SIGNIFICANCE
 If denture border is short of the hamular
notch, the denture will not have a posterior
seal resulting in loss of retention of the denture.

 If denture extend beyond hamular notch,

wide mouth causing dislodgement of denture.
 Also known as post dam.

 “The soft tissues at or along the

junction of the hard and soft
palate on which pressure along
the physiological limits of the
tissues can be applied by the
denture to aid in the retention of
the denture.”-GPT
PARTS
postpalatal seal
pterygomaxillary seal

EXTENSIONS
anteriorly- anterior vibrating line
posteriorly- posterior vibrating line
laterally- 3-4mm anterior-lateral to hamular notch
Pterygomaxillary seal

It is the part

posterior
of palatal
the seal that
extends across the
hamular notch and
extends 3 to 4 mm
anterolaterally to end in
the mucogingival junction
on the posterior part of the
maxillary ridge.
 Postpalatal seal

Part of the
posterior palatal seal area
that extends between the
two maxillary tuberosities.
 “The imaginary line across the posterior part of the palate marking
the division between the movable and immovable tissues of
the soft palate which can be identified when the movable
tissue is moving’’-GPT

 Denture should extend 1-2mm posterior to this vibrating lines.

 Types:

Anterior vibrating line

Posterior vibrating line
 CLINICAL SIGNIFICANCE:
 It maintains contact with the anterior portion of the soft palate during
functional movements of the stomatognatic system (i.e mastication,
deglutition and phonation). Therefore, the primary purpose of the
posterior palatal seal is the retention of maxillary denture.

 Reduces the tendency for gag reflex as it prevents the formation of the
gap between the denture base and the soft palate during functional
movements.

 Prevents food accumulation between the posterior border of the denture

and the soft palate.
SUPPORTING STRUCTURES OF
MAXILLA

PRIMARY STRESS BEARING

HARD PALATE
POSTERO-LATERAL SLOPES OF THE
RESIDUAL
ALVEOLAR RIDGE

SECONDARY STRESS BEARING AREA

RUGAE
MAXILLARY TUBEROSITY
ALVEOLAR TUBERCLE
Lined by keratinised epithelium.

The horizontal of the hard

palate provides the PRIMARY
STRESS- BEARING AREA.

CLINICAL SIGNIFICANCE
The trabecular pattern in the bone is
perpendicular to the direction of
force, making it capable of
withstanding any amount of force
without marked resorption.
RUGAE
 These are the mucosal folds located in the anterior
region of the palatal mucosa.

CLINICAL SIGNIFICANCE
 It is associated with the sensation of taste and the
function of speech.
 They also enable the tongue to form a perfect seal
when it is pressed against the palate in making linguo-
palatal constant stops of speech.
 Rugae should not be displaced,otherwise the
rebounding may dislodge the denture.
 They provide antero-posterior resistance to movement
of the denture and increased surface surface area
helps in retention.
 It is the bulbous extension of the
residual alveolar ridge in the
nd
and 3rd molar region, terminating2in
the hamular notch.
CLINICAL SIGNIFICANCE
The area is less likely to resorb.

Artficial teeth are not set on

tuberosity region.

The tuberosities sometimes

exhibit buccal undercuts, if it is
unilateral it can be utilized for the
retention.
These are areas in the denture bearing areas which should be
relived during construction of dentures.
Incisive papillae
Mid-palatine raphe
Fovea palatine
Palatine torus
Rugae
 INCISIVE PAPPILAE

It is the midline structure situated behind the

central incisors.
 Incisive foramen lies immediately beneath
the papillae.
 As resorption progresses, it comes to lie
nearer to the crest of the ridge.
 The naso-palatine nerves and vessels
pass through it.

CLINICAL SIGNIFICANCE
While makingfinal impression pressure
should not be applied on this region.
 This is the median suture area covered
by a thin sub-mucosa, so the mucosa
layer is in close contact with the
underlying bone
For this region, the soft tissue covering
the median palatal tissue is
non- resilient in nature and may need
to be relieved.

CLINICAL SIGNIFICANCE
If pressure is applied during
impression making,the denture base
will cause soreness over the
midpalatine raphe area.
PALATINE TORUS
A developmental bony prominence
sometimes seen in the centre of the
palate. This structure is often covered by
relatively incompressible mucoperiosteum

CLINICAL SIGNIFICANCE
Ifit is small, the denture is relieved
A mucosally supported denture may
need to be relieved over the torus to
prevent the denture rocking and flexing
about the mid line.
 These are the depresssions or indentations situated
on the soft palate on the either side of the midline.
 It is formed by coalescence of the duct of several
mucous glands.
 The position of the fovea palatinae also influences
the posterior border of the denture.

 The secretion of the fovea spreads as a thin film on the

denture therefore aiding in retention.
CLINICAL SIGNIFICANCE
 In patients with thick ropy saliva, the fovea palatinae
should be left uncovered or else the thick saliva flowing
between the tissue and the denture can increase the
hydrostatic pressure and displace the denture.
ANATOMICAL LANDMARKS
OF MANDIBLE
ANATOMY OF DENTURE
BEARING
AREAS- MANDIBLE
 These are areas in mandible that are closely related to the
base of the mandibular complete denture. They are covered
with mucosa and sub mucosa of varying degree of thickness
and compressiblity.

 The anatomical landmarks in the mandible are ;

LIMITING STRUCTURES
SUPPORTING STRUCTURES
RELIEF AREAS
 LABIAL FRENUM
 LABIAL VESTIBULE
 BUCCAL FRENUM
 BUCCAL VESTIBULE
 LINGUAL FRENUM
 ALVEOLOLINGUAL SULCUS
 RETROMOLAR PAD
 PTERYGOMANDIBULAR RAPHE
 It is a fold of mucous membrane at
the median line. It divides the labial vestibule
into left and right labial vestibule.
 It consist of band of fibrous connective tissue
and helps to attach orbicularis oris muscle.

 It is shorter and wider than the maxillary labial

frenum.

CLINICAL SIGNIFICANCE
 During final impression, making sufficient
relief must be given without compromising
the peripheral seal.
 The frenum is quite sensitive and active,
and the denture must be fitted carefully
around it to maintain a seal without causing
soreness.
LABIAL VESTIBULE

 Mentalis muscle is an active muscle. It

runs from the buccal frenum to buccal
frenum. It is divided into left and right by
labial frenum.
 Fibers of orbicularis oris,incisivus
and mentalis are inserted near the
crest of the ridge.

CLINICAL SIGNIFICANCE
 Extent of the denture flange in this region is
often limited because of muscle that are
inserted close to the crest of the ridge.
 Thick denture flanges may cause
dislodgement of dentures when patient
opens the mouth wide open.
 The buccal frenum forms the dividing
line between the labial and buccal
vestibule.
 May be single or double, broad
U shaped or sharp V shaped.
 It overlies depressor anguli oris
muscle.
Fibres of the buccinator muscle
attach to the frenum.

CLINICAL SIGNIFICANCE
Relieffor buccal frenum is given in
denture to avoid displacement of the
denture.
 BUCCAL VESTIBULE
Extends from buccal frenum to retromolar pad.
 It is nearly at right angles to biting forces.

 Extent of the buccal vestibule is influenced by

buccinators muscle,which extends from modiolous
anteriorly to pterygomandibular raphe.

 The masseter muscle contracts under heavy closing

force and pushes inward against the buccinators
muscle to produce a massetric notch in the distobuccal
border of the lower denture.
CLINICAL SIGNIFICANCE
 The distobuccal border of the lower denture should
accommodate the contracting masseter muscle so that
the denture does not dislodge during heavy closing
force.
 It is a fold of mucous membrane existing when
the tip of the tongue is elevated.
 It overlies the genioglossus muscle which takes
origin from the superior genial tubercle.
 The anterior region of the lingual flange is
called sub-lingual crescent area.

CLINICAL SIGNIFICANCE
 The relief for the lingual frenum should be
registered during function.
 A short frenum is called tongue tie. It should be
corrected if it affects the stability of the denture.
 It is the space between residual ridge and tongue.
 Extends from lingual frenum to retromylohyoid curtain
 It has 3 regions (anterior, middle and posterior)
 The anterior region extends from the lingual frenum back to where mylohyoid
muscle curves above the level of the sulcus (premylohyoid fossa)
 The middle region extends from premylohyoid fossa to the distal end of
the mylohyoid ridge, curving medially from the body of mandible
 The posterior region: here, the flange passes into the retromylohyoid
fossa
 TYPICAL S FORM of the correctly shaped lingual flange

CLINICAL SIGNIFICANCE
The lingual flange of the lower denture will be short anteriorly than posteriorly
The lingual flange in the middle region slopes medially towards the tongue
Alvelolingual sulcus:
anterior region
middle region
posterior region
‘S’ shaped alvelolingual sulcus
ALVEOLOLINGUAL
SULCUS-
RETROMYLOHYOID SPACE
 The retromylohyoid space lies at
distal end of the alveololingual
sulcus

 It is bounded by anterior
tonsillar pillar, posteriorly by
the retromylohyoid curtain
It is a non-keratinised triangular pear-shaped pad
of tissue at the distal end of the lower ridge.
Contains loose connective tissue with aggregation of
mucous glands.
Posteriorly - temporalis tendon,
Laterally-buccinator,
Medially-pterygomandibular raphe and
superior constrictor

CLINICAL SIGNIFICANCE
The distal end of the denture pad should
cover 2/3rd of the retromolar pad.
 The retromolar pad provides the
peripheral posterior seal for the lower
denture.
 Raphe is a tendinous insertion of two
muscles.
 Arises from the hamular process of
the medial pterygoid and gets attached to
the mylohyoid ridge.
 Muscular attachments present here are:
superior constrictor: postreolaterally
Buccinator: anterolaterally

CLINICAL SIGNIFICANCE
Since it is very some
patients, ainnotch like relief must be
prominent
provided on the denture.
SUPPORTING STRUCTURES OF THE
MANDIBLE
 These are areas responsible for bearing loads in the
mandible.

Buccal shelf area

Residual alveolar ridge
 It is the area between buccal frenum and anterior
border of masseter muscle.
 BOUNDARIES:

 Medially-the crest of the ridge.

 Distally-the retromolar pad
 Laterally-the external oblique ridge.

 The mucous membrane covering the buccal shelf

area is loosely attached, less keratinized and
contains a thick submucosa overlying a cortical plate.
CLINICAL SIGNIFICANCE
It lies at right angles to the vertical occlusal
force; this makes it suitable as primary stress
bearing area for lower denture.
RESIDUAL ALVEOLAR
RIDGE
The edentulous mandible may become flat, due to resorption; which
results
Similarlyinto
maxillaoutward inclination
resorbs upward and making
and inward progressively
it smaller.widening of
mandible.
 It is the reason for edentulous patients to have prognathic
apperance

 The slopes of residual alveolar ridge have thin plate of cortical

bone. The slopes of the ridge are at an acute angle to occlusal
forces.

CLINICAL SIGNIFICANCE.
 Any movable soft tissue overlying the ridge should not be
compressed while making impression.
 Mental foramen
 Genial tubercle
 Mylohyoid ridge
 Mandibular tori
 It lies between the and
premolar region. 1st 2nd

 Due to ridge resorption, it may lie

close to the ridge.

CLINICAL SIGNIFICANCE
It should be relieved in these areas
as pressure over the nerve passing
through it can get compressed by
denture base leading to
paraesthesia (numbness) of lower
lip.
 The genial tubercle are a pair of dense
prominences at the inferior border of the
mandible at the lingual midline
 They represents the muscle attachment of
the genioglossus and geniohyoid muscle.

CLINICAL SIGNIFICANCE
 They only become relevant in the denture
when there is excessive resorption of the
residual ridge.
 The mylohyoid ridge is a bony
prominence along the lingual aspect of
the mandible
 Soft tissue usually hides the sharpness of
the mylohyoid ridge
 Anteriorly, this ridge with mylohyoid
muscle is close to the inferior surface
of the mandible
 Posteriorly, after resorption, it often
flushes with the residual ridge.

CLINICAL SIGNIFICANCE
 The mucosa membrane overlying the sharp or
irregular mylohyoid ridge needs to be relieved
because denture base might easily traumatize it.
 These are the abnormal bony
prominence found bilaterally on the
lingual side, near the premolar region
but they may extend posteriorly to the
molar area
It is covered by thin mucosa.

CLINICAL SIGNIFICANCE
 It has to be relieved or surgically removed,
according to its size and extent.